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Eberhard Siebert, Occipital bending in depression, Brain, Volume 138, Issue 1, January 2015, Page e317, https://doi.org/10.1093/brain/awu198
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Sir,
I read with great interest the article by Maller et al. (2014) concerning occipital bending and its association with depression.
While there is a large body of sound and most interesting literature on brain asymmetry, I think that in some of these studies the brain is regarded in total isolation thereby neglecting its surrounding structures with their complicated anatomic inter-relationships and physiological interactions. Although it is true that the developing and growing brain determines the shape of its surrounding osseous structures, this interaction may not be exclusive and other anatomic and physiological factors may exert their influence on this process thereby determining the shape of the brain to some extent.
From a neuroangiographic point of view I would like to point out that skull base anatomy is asymmetric beyond direct brain association. It is well recognized that in most cases the jugular foramina are uneven in size, with the right one being significantly more capacious than the left in about two-thirds of cases (Rhoton, 2000). It is hypothesized by some that the more direct communication of the right jugular vein with the right atrium might cause unhindered back-propagation of right atrial pulse waves through the valve-less venous system, leading to an early dilatation and increase in capacity of the right-sided venous system (www.neuroangio.org). In contrast the left brachiocephalic vein is often smaller in size than its right-sided counterpart and appears to be squeezed between the structures of the superior thoracic aperture, possibly attenuating such pulse waves and even causing functional restriction of the left-sided exocranial flow in certain situations.
